Objective: The aim of this study was to evaluate clinical features of kala azar, transmitted by sand flies. It is the second most frequent infectious disease caused by parasites following malaria.

Methods: Five patients with kala azar presenting to our clinic between April 2004 and May 2007 were consecutively enrolled in our study. The diagnosis of the disease was based on clinical findings and detection of amastigot forms of the parasite in bone marrow, liver and spleen specimens. Three patients were living in a rural area and two in an urban area.

Results: Out of five cases, three were female and two were male with a mean age of 47 years (range: 3454 years). Two patients had a history of sand fly bites. The patients most frequently presented with fever, abdominal pain and weight loss. On history, one patient received treatment with steroids since he was found to have antinuclear antibodies during follow-up for accompanying hepatitis B and his exhaustion and weight loss increased. Meanwhile, the patient was found to have an increased erythrocyte sedimentation rate and globulin levels and underwent bone marrow biopsy. Obtained specimens showed Leishmania amastigots. The remaining two cases did not have any abnormalities in their bone marrow aspiration biopsies. However, they had widespread lymphadenopathy in the mediastinum and abdomen and fever of unknown origin. For these reasons, they underwent splenectomy. Obtained specimens showed Leishmania amastigots. All patients were administered liposomal amphotericin B 3 mg/kg daily for 5 days and once on days 14 and 21. None of the patients had relapses.

Conclusion: Kala azar may present with various clinical pictures in urban areas as well as in rural areas. We recommend that liver and spleen biopsies should also be performed since bone marrow biopsy may not show the parasite. Compared to conventional agents, liposomal amphotericin B seems to be a good treatment alternative in that it has fewer side-effects, requires a shorter treatment period and produces a satisfactory outcome.

Session Details

Date:

19/04/2008

Time:

00:00-00:00

Session name:

18th European Congress of Clinical Microbiology and Infectious Diseases